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Government Insurance Programs
Medicare - Nicole Najor. Contributed to by Ali Ayoub (underlined) Medicare is a health insurance plan that is available for United States (U.S.) citizens who are 65 years or older, or are qualified for disability benefits (The Difference between Medicare and Medicaid, 2018). This is a huge portion of our population, and will continue to grow with our baby boomer population. The large portion of these people who qualify for Medicare coverage makes it important to be knowledgeable of. The more a provider is familiar with insurance coverage, the better they can plan for their patients. This includes coverage for medications, procedures, imaging, lab tests, etc. In 2017, there were approximately 58 million Americans enrolled in Medicare plans (The Difference between Medicare and Medicaid, 2018). Because of its prevalence, we must look at the impact Medicare has on our economy and employment rates. According to Conesa et. al., (2017), getting rid of Medicare has a 2.7% decrease in payroll taxes and a 1.3% rise in wages. This study also found that getting rid of Medicare and its costs causes the rise in other government funded insurances, such as Medicaid, to rise in prices by billions of dollars. Therefore, if Medicare does become a larger issue to the economy and budgeting, it would not be very beneficial to get rid of it entirely. Changes would have to be made to qualifications in being eligible for the insurance coverage, as well as changes to other plans. There are different parts of Medicare to help cover specific services. For example, Medicare part A is widely know as hospital insurance that covers inpatient hospital stays, care in a skilled nursing facility, hospice care, and some home health care. Medicare part B is known as the medical insurance portion that covers certain doctors’ services, outpatient care, medical supplies, and preventative services. Medicare part D adds prescription drug coverage to some Medicare plans (Medicare.gov, n.d). Medicaid- Nicole Najor Medicaid is another government funded health insurance plan, funded by both federal and state levels, which provides coverage to individuals who qualify based on low income (The Difference between Medicare and Medicaid, 2018). Benefits to Medicaid include that there may not be premiums, coinsurance, or deductibles for visits and procedures. Medicaid also provides assistance and coverage to children (The Difference between Medicare and Medicaid, 2018). Due to the rise in baby boomers, people who are under the age of 65 and not eligible for Medicare and who are enrolled in Medicaid leads to an increase in the amount of spending for Medicaid, particularly on care for chronic diseases, nursing homes, and prescription medications (Keehan, et. al., 2015). This is also due to the Affordable Care Act providing Medicaid coverage expansion due to the rising aging population. Other Government Programs- Brandie Jones, Contributed to by Kelly Doherty (underlined) The government has multiple programs within Medicare and Medicaid to assist with health care needs. One program that is available for Medicare and Medicaid members is Programs of All-Inclusive Care for the Elderly (PACE). PACE is a government Program for Medicare and Medicaid who are 55 years or older who need some type of nursing home care (Gonzalez, 2017). Outside members are also excepted but must pay a monthly fee. PACE was created to help the elderly remain in the community as an alternative to a nursing home. State Children's Health Insurance Program (SCHIP)- this program is paid for both on a state and federal level to insure kids who qualify for health care insurance (Hodgson, 2005). This program was started in 1997, for kids under the age of 18 without any other means to healthcare. (Corrigan, Eden, & Smith, 2002). SCHIP, or CHIP, was funded by Congress allotting $40 million in block grants over a 10-year span. CHIP was re-authorized both in 2009 and 2010 through the Children’s Health Insurance Program Reauthorization Act and Affordable Care Act (Children’s Health Insurance Program, 2014). Between the time of enactment in 1997 to 2011, enrollment in this program has grown to include coverage for 5.3 million children. Findings have indicated that enrollment within CHIP has increased access to care, as well as the utilizations of primary and preventative services (Children’s Health Insurance Program, 2014). Department of Defense TRICARE and TRICARE for Life programs (DOD TRICARE)- This program was started in 1989, within this program healthcare is provided to active military members, their dependents and retirees under the age of 65. (Corrigan, Eden, & Smith, 2002) Veterans’ Health Administration (VHA) program- This program was started in 1946, this program was started to take care of military members who were injured while serving in the military. (Corrigan, Eden, & Smith, 2002) Indian Health Service (IHS) program- This program provides health care services to Indians, who have been proven to be a member of select American Indian and Alaska Native tribes. (Corrigan, Eden, & Smith, 2002). According to the U.S. Department of Health and Human Services, the IHS is an agency that federally provides health services to American Indian and Alaskan Natives (2018). In 1976, Congress passed the Indian Health Care Improvement Act (IHCIA) (2018). Within this Act, funding for national programs was granted to IHS (2018). IHS currently provides health care to 2.3 million American Indians and Alaskan Natives; these members are a part of over 573 federally recognized tribes spanning 35 states (IHS Profile, 2018). In 2017, the IHS facilities funded approximately 39,367 inpatient admissions, and 13,811,171 outpatient visits (IHS Profile, 2018).